Healthcare Provider Details

I. General information

NPI: 1942379979
Provider Name (Legal Business Name): BETTY HASH LYON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HYDRAULIC RD
CHARLOTTESVILLE VA
22901-8915
US

IV. Provider business mailing address

1420 STABLE LN
CHARLOTTESVILLE VA
22901-8882
US

V. Phone/Fax

Practice location:
  • Phone: 434-973-2968
  • Fax:
Mailing address:
  • Phone: 434-296-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401007477
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: